Patients with what enzyme deficiency can suffer additional toxicities of sulfonamide antibiotics?
People with glucose-6-phosphate dehydrogenase deficiency will get hemolytic anemia
Sulfonamides can cause which renal pathology?
What neurologic injury can sulfonamides cause in infants?
How do sulfonamides affect the plasma concentration of albumin-bound drugs such as warfarin?
The plasma concentration of warfarin and other drugs is raised by displacement from albumin by sulfonamides
What skin condition can sulfonamides cause?
Which two drugs inhibit dihydrofolate reductase?
Trimethoprim and pyrimethamine
Which drugs can be dosed with sulfonamides for synergistic inhibition of bacterial DNA synthesis?
Trimethoprim and pyrimethamine
What reaction is catalyzed by dihydrofolate reductase?
The conversion of dihydrofolic acid to tetrahydrofolic acid
Why are trimethoprim and sulfamethoxazole used in combination?
To cause the sequential block of folate synthesis and synergistic inhibition of DNA synthesis
Trimethoprim-sulfamethoxazole is used to treat what pulmonary infection of HIV-positive patients?
Pneumocystis jiroveci pneumonia
Trimethoprim-sulfamethoxazole is used to treat which infections?
Recurrent urinary tract infections, Shigella, Salmonella, and (in HIV-positive patients) Pneumocystis jiroveci pneumonia
What part of the body is most affected by the adverse effects of trimethoprim-sulfamethoxazole treatment?
The blood cell precursors in bone marrow (remember: TMP Treats Marrow Poorly)
What hematologic toxic effects are seen with the use of trimethoprim-sulfamethoxazole?
Megaloblastic anemia, leukopenia, and granulocytopenia (remember: TMP Treats Marrow Poorly)
The toxic bone marrow effects seen with the use of trimethoprim-sulfamethoxazole may be alleviated with the administration of what supplement?
Patients who do not tolerate sulfa drugs should not be given which drugs?
Sulfonamide antibiotics, sulfonylureas, sulfasalazine, and most diuretics (including furosemide, thiazides, and acetazolamide)
Name seven examples of fluoroquinolones.
Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, and enoxacin
Fluoroquinolones inhibit what enzyme?
DNA gyrase (topoisomerase II)
Which organisms are targeted by fluoroquinolones?
Gram-negative rods (in the urinary and gastrointestinal tracts) including Pseudomonas, Neisseria, and some gram-positive organisms
Fluoroquinolones are contraindicated in pregnant women and children because of possible damage to what structure?
The cartilage (remember: fluoroquinolones hurt attachments to your Bones)
What musculoskeletal adverse effects are seen in adults with fluoroquinolone toxicity?
Tendonitis and tendon rupture
What musculoskeletal complaints do children with fluoroquinolone toxicity have?
Leg cramps and myalgias
What is the mechanism of action of metronidazole?
Toxic metabolites formed in the bacterial cell damage DNA
Metronidazole is used with what two agents as "triple therapy" against Helicobacter pylori?
Bismuth and amoxicillin; another option for triple therapy is omeprazole, amoxicillin, and clarithromycin
What may happen when patients taking metronidazole consume alcohol?
Name two common adverse effects of metronidazole.
Headache and metallic taste
Name six infections that are treated using metronidazole.
Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, Helicobacter pylori (remember: GET GAP on the Metro)
What is the mechanism of action of polymyxins?
They bind to the cell membrane, disrupting the osmotic properties of the bacterial cell (remember: PolyMYXins MIX up membranes)
Polymyxins are _____ (anionic/cationic) basic proteins that act like _____ (detergents/enzymes).
What kind of infection are polymyxins used to treat?
Resistant gram-negative infections
What are the two major toxicities of polymyxins?
Neurotoxicity and acute renal tubular necrosis